S.699 - Purchased and Referred Care Improvement Act of 2025 (119th Congress)
Summary
The Purchased and Referred Care Improvement Act of 2025 (S.699) amends the Indian Health Care Improvement Act to address liability for payment of charges associated with purchased/referred care services provided by the Indian Health Service (IHS). It ensures that patients are not held liable for costs not covered by the IHS and establishes procedures for reimbursing patients who pay out-of-pocket for authorized care. The bill also makes technical and conforming amendments to update terminology and references within the Indian Health Care Improvement Act.
Expected Effects
This act will likely result in improved financial protection for Native American patients receiving care through the IHS. It clarifies payment responsibilities and reduces the burden of unexpected medical bills. The changes aim to streamline the reimbursement process and update relevant documentation to reflect the new policies.
Potential Benefits
- Financial Protection: Patients receiving purchased/referred care will not be held liable for costs not covered by the IHS.
- Reimbursement Procedures: Establishes clear procedures for patients to be reimbursed for out-of-pocket expenses.
- Updated Terminology: Modernizes the language used in the Indian Health Care Improvement Act, replacing "contract health service" with "purchased/referred care".
- Improved Notification: Requires the Secretary to notify providers and patients about payment liabilities.
- Retroactive Application: The amendments apply to care authorized on, before, or after the enactment date.
Potential Disadvantages
- Potential Administrative Burden: Establishing and implementing new reimbursement procedures may create administrative challenges for the IHS.
- Tribal Agreement Requirement: Reimbursement procedures do not automatically apply to programs operated by Indian tribes under self-determination contracts unless expressly agreed to, potentially creating inconsistencies.
- Implementation Timeline: Requires the Secretary to establish procedures and update authorities within specified timeframes, which may pose challenges for timely execution.
- Unintended Consequences: While aiming to protect patients, the changes could potentially impact the financial stability of healthcare providers if not implemented effectively.
- Limited Scope: The act primarily focuses on financial aspects of purchased/referred care and does not address broader issues related to healthcare access or quality.
Constitutional Alignment
This bill appears to align with the constitutional authority of Congress to legislate regarding Native American affairs, stemming from the Commerce Clause (Article I, Section 8) and treaty-making powers. The provision of healthcare services to Native Americans is a recognized federal responsibility, and this bill seeks to improve the administration and financial aspects of those services. There is no apparent conflict with individual rights or freedoms guaranteed by the Constitution or its amendments.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).